| NPI | 1710022975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD050295L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA05298400) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2018-04-13 |