| NPI | 1295798262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB07045200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 54675) |
| 207Q00000X Family Medicine (Licence: PA OS 009951L) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2017-11-29 |