| NPI | 1871661041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: DE C1-0004306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA05838200) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2016-03-09 |