| NPI | 1750529012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB09141300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS015646) |
| Enumeration Date | 2009-01-25 |
| Last Update Date | 2012-12-05 |