| NPI | 1487233375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 339374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA12759000) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2025-09-03 |