| NPI | 1841236080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MA06090400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 056359) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2011-02-03 |