| NPI | 1578881090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09174100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY applied for) |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2012-11-21 |