| NPI | 1083027056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H009163) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB10123400) |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2022-07-06 |