| NPI | 1770837833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB09355800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ NONE- PGY2) |
| Enumeration Date | 2012-10-28 |
| Last Update Date | 2023-03-07 |