| NPI | 1780697490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MA02694700) |
| Additional Taxonomies | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: NJ 25ma04825700) |
| 207V00000X Obstetrics & Gynecology (Licence: NJ MA02694700) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA02694700) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25ma04825700) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NJ 25ma04825700) | |
| 2086S0129X (Licence: NJ 25MA02694700) | |
| 208VP0000X (Licence: NJ MA02694700) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2021-12-10 |