| NPI | 1174102800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS022742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB12889300) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2025-11-11 |