| NPI | 1134564768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA10237900) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD456846) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2026-05-19 |