| NPI | 1164083002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA11520500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT219116) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2024-06-04 |