| NPI | 1922021138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB03630600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB36306) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-12-02 |