| NPI | 1306805015 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25ma08475500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 213389) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2014-01-22 |