| NPI | 1598809147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08710900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 212253) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2023-03-17 |