| NPI | 1811930027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MA064323) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA064323) |
| 207V00000X Obstetrics & Gynecology (Licence: NJ MA064323) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-11-27 |