| NPI | 1801932751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS013790) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB08984400) |
| 208D00000X General Practice (Licence: PA OS013790) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2024-10-13 |