| NPI | 1346279601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB044766) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 05008272L) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-02-01 |