| NPI | 1619318177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09871400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA09871400) |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2021-11-04 |