| NPI | 1730108077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD-047555-L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA 55739) |
| 207R00000X Internal Medicine (Licence: FL MA 0067967) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-09 |