| NPI | 1053351924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MB74824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS-013105) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2019-09-27 |