| NPI | 1225770522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA12840500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD491775) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2025-10-06 |