| NPI | 1689751646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA07629900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA076299) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-10-20 |