| NPI | 1023545498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA10868200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD475231) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2024-06-07 |