| NPI | 1417915968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB065920) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS008958L) |
| 207R00000X Internal Medicine (Licence: PA OS008958L) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2016-10-14 |