| NPI | 1861574279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA58280) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2023-10-12 |