| NPI | 1134142458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS008264L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB07820100) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-07-11 |