| NPI | 1144255506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA03922600) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NJ 25MA03922600) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2009-07-11 |