| NPI | 1356500458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD434027) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08400800) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2008-07-24 |