| NPI | 1790212892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA1238600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 305801) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2024-12-30 |