| NPI | 1386638377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MB48542) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS006080E) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2021-01-20 |