| NPI | 1245263771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB062224) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 0S008238L) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2013-10-02 |