| NPI | 1144516865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 266419) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08954800) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2015-12-14 |