| NPI | 1114125234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA09334100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP01065) |
| 207R00000X Internal Medicine (Licence: RI MD13029) | |
| 207R00000X Internal Medicine (Licence: CT 51605) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2023-01-05 |