| NPI | 1336145465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA04041400) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ MA40414) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2008-04-24 |