| NPI | 1427045665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 246061) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA04643400) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2008-03-24 |