| NPI | 1700172459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NJ 25MA09852500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09852500) |
| 207Q00000X Family Medicine (Licence: VA 0116023382) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2024-04-10 |