| NPI | 1396327136 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA11977700) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NJ 25MA11977700) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2024-07-05 |