| NPI | 1366936742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA11050800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301115844) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2025-11-12 |