| NPI | 1801010723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB08209300) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ MB82093) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2024-02-20 |