| NPI | 1467708271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MA09133000) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 21312) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2020-08-26 |