| NPI | 1942275078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QA0005X Clinic/Center, Ambulatory Family Planning Facility (Licence: NJ 25MA02833100) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NJ 25MA02833100) |
| 332900000X Non-Pharmacy Dispensing Site (Licence: NJ 25MA02833100) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2023-03-07 |