| NPI | 1417927955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NJ 25MA07324500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA07324500) |
| 207R00000X Internal Medicine (Licence: NY 217493-2) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2016-11-02 |