| NPI | 1558652198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA10329500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA10329500) |
| 207Q00000X Family Medicine (Licence: PA MD453551) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD453551) | |
| Enumeration Date | 2011-05-01 |
| Last Update Date | 2023-11-29 |