| NPI | 1104216688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 61069) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09938800) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2019-09-30 |