| NPI | 1912194069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 174829) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 51907) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2011-12-02 |