| NPI | 1972564227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA03592200) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA03592200) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2014-09-08 |