| NPI | 1285306068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0029766) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA13104500) |
| 207R00000X Internal Medicine (Licence: MD D0107544) | |
| 208D00000X General Practice (Licence: NY 110396-02) | |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2026-09-18 |