| NPI | 1902118821 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA11084900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME136772) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2024-05-17 |