| NPI | 1275521023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME050857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA046778) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2021-09-16 |