| NPI | 1245528629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 262326) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA10328100) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2023-03-15 |