| NPI | 1336593706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA10662800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 35432) |
| 207R00000X Internal Medicine (Licence: OH 35.138301) | |
| 207R00000X Internal Medicine (Licence: SC 83707) | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2020-11-11 |