| NPI | 1114193984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08448200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD4355193) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2021-05-14 |