| NPI | 1780067280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA11518100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 55126) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2024-05-09 |