| NPI | 1790885275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB03948400) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MB03948400) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2014-02-06 |