| NPI | 1619146677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08855100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 255630-1) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2011-01-05 |