| NPI | 1275584914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 27522) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08064700) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2021-07-07 |