| NPI | 1811976970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 211807) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08719200) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2012-09-26 |