| NPI | 1649218975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS003457L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB03196100) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2013-11-17 |