| NPI | 1477866150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA10760900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD448708) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2020-02-25 |