| NPI | 1194816207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NJ 25MB04030300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB04030300) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2012-05-03 |