| NPI | 1104922087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA07450300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA07450300) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2011-03-03 |