| NPI | 1174903256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS025492C) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB10407700) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2026-01-09 |