| NPI | 1750538609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08471700) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA08471700) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2012-10-02 |