| NPI | 1669536959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08186500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD429827) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2025-01-20 |