| NPI | 1730765421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 196942) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA12046100) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-05-29 |