| NPI | 1487640306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NJ 25MA06471400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA06471400) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2025-10-03 |