| NPI | 1235209560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA07294900) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA07294900) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-12-07 |