| NPI | 1699186114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD460893) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA10651800) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2021-09-23 |