| NPI | 1629136932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 187106) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA03664000) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2026-06-08 |