| NPI | 1821095605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MB06972800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200100701) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-12-10 |