| NPI | 1558707620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09804400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 285214) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2022-03-30 |