| NPI | 1023304946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 36854) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25ma09345600) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2017-03-07 |