| NPI | 1932536232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017795) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 207Q000X) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2018-08-02 |