| NPI | 1346691961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 81123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB10537500) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2025-08-07 |