| NPI | 1487651675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MB03341100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ mb33411) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2022-04-08 |