| NPI | 1982686408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB05992500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS013021) |
| 208000000X Pediatrics (Licence: NJ 25MB05992500) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2023-03-07 |