| NPI | 1639256696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA06793300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA67933) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2014-12-05 |