| NPI | 1477528529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB06649500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB066495) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2023-11-27 |