| NPI | 1861789745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10689500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 207Q00000X) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2021-07-15 |