| NPI | 1124519087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA11099300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD475585) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2024-11-13 |