| NPI | 1912987009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO153217) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MB07614600) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2021-02-15 |