| NPI | 1578067013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 95788) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA11121900) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2023-10-25 |