| NPI | 1487728291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08542700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 242168) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2021-09-24 |