| NPI | 1881605202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME74534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08130700) |
| 207R00000X Internal Medicine (Licence: FL ME0074534) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2013-02-25 |