| NPI | 1104970417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME96603) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101264898) |
| 207R00000X Internal Medicine (Licence: NJ 25MA09668800) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2025-02-11 |