| NPI | 1215247820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS016230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB09539000) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2022-09-12 |