| NPI | 1023371762 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB11791400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS017816) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2023-10-06 |