| NPI | 1285677492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB03346400) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 033464) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-11-04 |