| NPI | 1659768588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA11373100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.309290) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2022-04-12 |