| NPI | 1124076393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08910000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 125089) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-12-09 |