| NPI | 1043448624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10545300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD444198) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2020-10-18 |