| NPI | 1255364105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101256632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08039300) |
| 207R00000X Internal Medicine (Licence: MD D0071763) | |
| 207Q00000X Family Medicine (Licence: VA 0101256632) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2023-09-08 |