| NPI | 1518607787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 6824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102209567) |
| 207Q00000X Family Medicine (Licence: NJ P23-01104) | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-09-17 |