| NPI | 1740554914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD461008) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ Do not have yet) |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2020-04-22 |