| NPI | 1669574075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB11241600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-22853) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2024-05-07 |