| NPI | 1932348562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08567500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 003236) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2018-08-29 |