| NPI | 1790942076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NJ 25MA09287800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09287800) |
| 207Q00000X Family Medicine (Licence: CA A105931) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2022-12-02 |