| NPI | 1346461621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 097124) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA02648200) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2011-11-23 |