| NPI | 1235832627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 1992911937) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 10535854) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2023-03-24 |