| NPI | 1942694419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 296393) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA10165100) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2021-11-24 |