| NPI | 1225598733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 316682) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB11520300) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2022-06-29 |