| NPI | 1245239011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME100391) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0061827) |
| 207R00000X Internal Medicine (Licence: FL ME100391) | |
| 207R00000X Internal Medicine (Licence: NJ 25MA08650500) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2016-07-16 |