| NPI | 1598257354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA11104100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT215155) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2021-06-28 |