| NPI | 1104492982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA12085600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD483223) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2024-08-27 |