| NPI | 1104485416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB11502800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS021618) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2023-08-02 |