| NPI | 1124072194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104650) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.134852) |
| 207R00000X Internal Medicine (Licence: NJ MA07934400) | |
| 207R00000X Internal Medicine (Licence: NY 236677) | |
| 207R00000X Internal Medicine (Licence: TN 51663) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2021-03-26 |