| NPI | 1538390158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 67533) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB09009700) |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2014-05-12 |