| NPI | 1710291307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25mb09368400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 266942-1) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2016-04-22 |