| NPI | 1063826519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA10123800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT207385) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2022-07-21 |