| NPI | 1861488736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 008575) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB07739200) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2025-01-30 |