| NPI | 1215935531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2013-0931) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA07166600) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2024-06-24 |