| NPI | 1487987236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS016447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB09026300) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2014-01-30 |