| NPI | 1083097554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10444400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 295638) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2019-07-24 |