| NPI | 1104552124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 293972) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA12768900) |
| Enumeration Date | 2022-08-01 |
| Last Update Date | 2026-04-06 |