| NPI | 1720158025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 22618) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 103223) |
| 208D00000X General Practice (Licence: FL 23311) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2010-08-31 |