| NPI | 1396087987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA09765900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25ma09765900) |
| 207Q00000X Family Medicine (Licence: NY 306082) | |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2023-05-30 |