| NPI | 1871580647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 196000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA08841200) |
| 208000000X Pediatrics (Licence: NY 196000) | |
| 207R00000X Internal Medicine (Licence: NJ 25MA08841200) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2022-02-25 |