| NPI | 1063795284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD455348) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09662300) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2017-05-12 |