| NPI | 1205989241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09101700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD064961L) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2019-06-25 |