| NPI | 1265880652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB10565900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT016894) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2020-08-13 |