| NPI | 1003961319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME61640) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 42389) |
| 207R00000X Internal Medicine (Licence: NJ 25MA08984100) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2023-06-28 |