| NPI | 1992769913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB09157800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS009158L) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2026-05-05 |