| NPI | 1114230232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME166594) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A139358) |
| 207R00000X Internal Medicine (Licence: IL 125057972) | |
| 207R00000X Internal Medicine (Licence: NJ 25MA10668500) | |
| Enumeration Date | 2010-07-18 |
| Last Update Date | 2024-03-05 |