| NPI | 1245729979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA12752300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 32010) |
| 207Q00000X Family Medicine (Licence: DE C1-0026423) | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2026-06-01 |