| NPI | 1326891474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD044582E) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA07523000) |
| Enumeration Date | 2024-04-09 |
| Last Update Date | 2024-04-09 |