| NPI | 1518920552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB06286100) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NJ 25MB06286100) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MD 2014416) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2023-07-19 |