| NPI | 1972564631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD044703Y) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NJ 25MA05690300) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD044703Y) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MA05690300) | |
| 207R00000X Internal Medicine (Licence: NJ 25MA05690300) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2021-02-02 |