| NPI | 1497123418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL A PEDERSEN Sole Member 856-630-5506 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB09405100) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2015-09-08 |