| NPI | 1174555486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 214116) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ ma069239) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-05-26 |