| NPI | 1336245356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB11689300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 200268) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2025-07-17 |