| NPI | 1477545598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS 010838-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB12191200) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2025-03-31 |