| NPI | 1093397879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB13063200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT020582) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2026-06-19 |