| NPI | 1750463527 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: NJ MB66828) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NJ MB66828) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2007-07-08 |