| NPI | 1851605919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6355) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09314100) |
| Enumeration Date | 2010-08-01 |
| Last Update Date | 2021-05-14 |