| NPI | 1851390470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08440400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 233296) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2011-01-13 |