| NPI | 1750416814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD027798l) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA01903100) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |