| NPI | 1518944784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA03754600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 56471) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MA03754600) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA03754600) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2024-02-27 |