| NPI | 1538597166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB09783000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 196143) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2019-09-05 |