| NPI | 1962455014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA11544500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0091938) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-12-06 |