| NPI | 1770011439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA11678300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 302900) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2023-01-26 |