| NPI | 1295727790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 40223) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MF070336L) |
| 207R00000X Internal Medicine (Licence: MD D0068235) | |
| 207R00000X Internal Medicine (Licence: NJ 25MA07022100) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2021-04-19 |