| NPI | 1336377712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10978800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD444818) |
| 207Q00000X Family Medicine (Licence: OK 29995) | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2021-04-07 |