| NPI | 1841569167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD446833) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT187497) |
| 207R00000X Internal Medicine (Licence: NJ 25MA09029400) | |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2022-09-14 |