| NPI | 1861742124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS018441) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS15684) |
| 207R00000X Internal Medicine (Licence: NJ 25MB09676100) | |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2021-02-22 |