| NPI | 1124324504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 268917) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB10677100) |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2020-06-09 |