| NPI | 1609432186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB11868200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS021398) |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2023-09-01 |