| NPI | 1639592983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB10027900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0320134219) |
| 207Q00000X Family Medicine (Licence: NY 273509-1) | |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2024-11-08 |