| NPI | 1912393281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A177794) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA10312300) |
| 207R00000X Internal Medicine (Licence: OH 36.136286) | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2022-08-11 |