| NPI | 1295980969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09414100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD440059) |
| Enumeration Date | 2008-11-23 |
| Last Update Date | 2014-05-28 |