| NPI | 1811955875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS021081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB07964100) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2021-05-12 |