| NPI | 1245424159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 68315) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA05128900) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2026-07-16 |