| NPI | 1265932131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 309514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB11160900) |
| Enumeration Date | 2018-02-17 |
| Last Update Date | 2024-01-17 |