| NPI | 1578504676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD030707E) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA41042) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2009-12-03 |