| NPI | 1851674907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB090482400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 263684) |
| 207Q00000X Family Medicine (Licence: PA OS015796) | |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2019-06-11 |