| NPI | 1730352576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB08243000) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: NJ 25MB08243000) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2015-09-11 |