| NPI | 1558854414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OT018658) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB11701100) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2023-02-08 |