| NPI | 1285932079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME110476) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ no licence) |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2012-02-24 |