| NPI | 1497287072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 5382) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB10946400) |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2023-09-11 |