| NPI | 1053413724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD070055L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 57945) |
| 207R00000X Internal Medicine (Licence: DE C1-0005898) | |
| 207R00000X Internal Medicine (Licence: NJ 25MA05721900) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2007-07-08 |