| NPI | 1770894495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09546300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA mt198044) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2023-02-07 |