| NPI | 1730347212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08678600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT191538) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2014-10-15 |