| NPI | 1396708657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09880900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 286560) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2021-04-15 |