| NPI | 1699713404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25mb03346000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS003734L) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2007-07-08 |