| NPI | 1396090411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 278763) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09191000) |
| Enumeration Date | 2012-07-14 |
| Last Update Date | 2025-09-23 |