| NPI | 1407590557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS025274) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB12320100) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2026-03-20 |