| NPI | 1629365283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 71759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08963000) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2024-05-09 |