| NPI | 1902005960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 237857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB10207000) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2024-04-26 |