| NPI | 1861176182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB12974100) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2024040709) |
| 207Q00000X Family Medicine (Licence: MO 2024040709) | |
| 207Q00000X Family Medicine (Licence: MO 2023022824) | |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2026-09-21 |