| NPI | 1457621500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 262185) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09127000) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2024-07-24 |