| NPI | 1851546352 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08620300) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2018-04-04 |