| NPI | 1396742342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME139910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA05673800) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2025-07-18 |