| NPI | 1891722047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS003690L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB33444) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2014-09-03 |