| NPI | 1477806339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 55145) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME131244) |
| 207R00000X Internal Medicine (Licence: NJ 25MA10827200) | |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2022-02-15 |