| NPI | 1376118406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 323712) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA12262400) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2024-06-14 |