| NPI | 1003298118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS019362) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB11436600) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2025-05-13 |