| NPI | 1457359713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 64058) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA06405800) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2024-01-19 |