| NPI | 1407830086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS-002606-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 053167) |
| 207Q00000X Family Medicine (Licence: NJ 25MB02319500) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2013-10-10 |