| NPI | 1245659028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101273808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09834500) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2022-08-10 |