| NPI | 1679513063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MA05812700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA58127) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2024-04-05 |