| NPI | 1770553968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB10166900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS011938) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2018-03-17 |