| NPI | 1205032513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2010-0233) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 39) |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2022-02-10 |