| NPI | 1386933521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA11129900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-135381) |
| 207R00000X Internal Medicine (Licence: TX Q5890) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2021-08-31 |