| NPI | 1114988110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 213539) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA11671800) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2025-03-27 |