| NPI | 1659692887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10385500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT209606) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2018-08-24 |