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 |