| NPI | 1639586845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB10071500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 274346-224) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2021-09-03 |