| NPI | 1225211097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 046212) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 246882-1) |
| 208D00000X General Practice (Licence: NJ 25MA08415900) | |
| 208D00000X General Practice (Licence: CT 046212) | |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2019-12-06 |