| NPI | 1174775720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA02220400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA02220400) |
| 208D00000X General Practice (Licence: NJ 25MA02220400) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2008-10-15 |