| NPI | 1669588422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA07147400) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA07147400) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2009-09-09 |