| NPI | 1306337175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NJ 25MB11706700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018356) |
| Enumeration Date | 2018-05-28 |
| Last Update Date | 2023-07-01 |