| NPI | 1093040115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 255828) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25ma08645900) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2010-02-18 |