| NPI | 1114030996 |
|---|---|
| Other Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD433074) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08100500) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2010-11-02 |