| NPI | 1164446472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA06177300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA61773) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-02-15 |