| NPI | 1720191778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB07716400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS012536) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-10-16 |