| NPI | 1669482428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA07132800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 216866) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2018-06-05 |