| NPI | 1659721959 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA10537800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT210942) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2019-07-19 |