| NPI | 1255624896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 275285) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB09378700) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2019-07-18 |