| NPI | 1093753816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA06291300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA62913) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2021-04-13 |