| NPI | 1003998345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME119330) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA62807) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-11-04 |