| NPI | 1164676037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101254080) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 047100) |
| 207R00000X Internal Medicine (Licence: NJ 25MA97511800) | |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2022-08-19 |