| NPI | 1275643116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NJ MB055641) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: NJ MB055641) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2011-05-25 |