| NPI | 1285045419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA10186800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206243) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2018-03-17 |