| NPI | 1134611262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB11015100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C2-0024119) |
| 208D00000X General Practice (Licence: NJ 25MB11015100) | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2024-05-30 |