| NPI | 1942341458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA04691800) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: NJ 25MA04691800) |
| 207QA0505X Family Medicine Adult Medicine (Licence: NJ 25MA04691800) | |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: NJ 25MA04691800) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2011-10-18 |