| NPI | 1881372357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MB12856400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB12856400) |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2025-12-15 |