| NPI | 1770686289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA41866) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME62196) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2009-05-13 |