| NPI | 1407897689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: NJ 25MA03205500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 25MA03205500) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2011-06-02 |