| NPI | 1265528111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C143677) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA59128) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2024-01-05 |