| NPI | 1417215468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA10189600) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: DE CI-0011354) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2019-07-09 |