| NPI | 1073884680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB09055800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA os015903) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2021-10-04 |