| NPI | 1811986391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB079990) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS010895L) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2012-01-10 |