| NPI | 1770553042 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB09098500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C2-0005697) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2014-02-05 |