| NPI | 1275624660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 251034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA8125400) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2017-01-11 |