| NPI | 1972653384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD065771L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA69121) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-06-26 |