| NPI | 1295629939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA SP033036) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 26NJ15425000) |
| Enumeration Date | 2025-06-06 |
| Last Update Date | 2026-02-26 |