| NPI | 1609006618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10672000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0073254) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2021-02-15 |