| NPI | 1255509873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD436175) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MA08756900) |
| Enumeration Date | 2008-02-16 |
| Last Update Date | 2018-01-08 |