| NPI | 1295727121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB04654200) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NJ 25mb04654200) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2024-03-15 |