| NPI | 1063464808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA01729300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA017293) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2019-10-23 |