| NPI | 1790198133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10591600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-9361) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2025-09-29 |