| NPI | 1619282175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08818500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD441457) |
| 207R00000X Internal Medicine (Licence: FL ME129934) | |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2023-03-08 |