| NPI | 1932308905 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NJ 25MA03463300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA03463300) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2007-07-11 |