| NPI | 1467539379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MB0066720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA PA05008396L) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2018-01-10 |