| NPI | 1497784094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA07503100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA075031) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2014-11-25 |