| NPI | 1871609149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA05096200) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NJ MA50962) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2017-05-05 |