| NPI | 1891718185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10191700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C10004793) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-07-06 |