| NPI | 1679696843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MA03465400) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NJ 25MA03465400) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2022-07-07 |