NPI | 1861661704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB08679900) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 243528) |
208D00000X General Practice (Licence: NY 243528) | |
Enumeration Date | 2008-02-25 |
Last Update Date | 2021-09-26 |