| NPI | 1033117171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MA056567) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA05656700) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2012-05-21 |