| NPI | 1629150024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MB52176) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB05217600) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2024-08-05 |