| NPI | 1518957109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA04456200) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NJ MA2504456200) |
| 207Q00000X Family Medicine (Licence: NY 177076-1) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2010-04-28 |