| NPI | 1346279494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine Adolescent Medicine (Licence: NJ 25MA070959) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: NJ 25MA070959) |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: NJ 25MA070959) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2007-07-08 |