| NPI | 1134417587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA09812000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-059397) |
| 207RN0300X Internal Medicine, Nephrology (Licence: NJ 25MA09812000) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2018-05-22 |