| NPI | 1881997641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD451214) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08871100) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2023-03-14 |