| NPI | 1710148614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09024500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 21154) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2023-12-20 |