| NPI | 1336111939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB06503400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102201577) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2013-07-10 |