| NPI | 1629017652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS16624) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MB43067) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2021-12-14 |