| NPI | 1083812994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME99046) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08203400) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2025-07-03 |