| NPI | 1891017000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD435320) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA MD.014835) |
| 208D00000X General Practice (Licence: NJ 25MA08478500) | |
| Enumeration Date | 2010-02-16 |
| Last Update Date | 2010-02-16 |