| NPI | 1821328527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD016749E) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA07094500) |
| 207R00000X Internal Medicine (Licence: DE C10005407) | |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2010-01-04 |