| NPI | 1124040407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08663100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD418877) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2019-05-14 |