| NPI | 1093209520 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB12496100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 312345) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2025-01-30 |