| NPI | 1508898792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA04613800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD426521) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD426521) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2023-06-08 |