| NPI | 1144803164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 328386) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA12034400) |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2024-04-01 |