| NPI | 1659630895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD455675) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA10155100) |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2023-05-12 |