| NPI | 1770569568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MB03186200) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ MB03186200) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2023-03-07 |