| NPI | 1376514968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA07834000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD070258L) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2020-10-19 |