| NPI | 1457602328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA12369600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD455099) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2025-07-24 |