| NPI | 1750483301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS004982L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB04085500) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2021-04-27 |