| NPI | 1356921860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS023908) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB12128900) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2026-08-05 |