| NPI | 1639507510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB10210800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H0080015) |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2021-06-16 |