| NPI | 1073547428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA05929200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD039412L) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2011-09-23 |