NPI | 1689929085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 277719) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 202845) |
207R00000X Internal Medicine (Licence: NJ NJDCATEMP-008277) | |
Enumeration Date | 2012-07-21 |
Last Update Date | 2020-05-19 |