| NPI | 1215272943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS020230) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB09244100) |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2023-06-27 |