| NPI | 1952325334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA05637000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA56370) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2014-08-29 |