| NPI | 1639151129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA06375300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA06375300) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2020-08-21 |