| NPI | 1750466439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA04752500) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: NJ 25MA04752500) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2024-04-17 |