| NPI | 1780644831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS003693L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB03357700) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2022-09-26 |