| NPI | 1659379865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MA05968800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA05968800) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2024-04-11 |