| NPI | 1295078145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 14267400-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD459495) |
| 207R00000X Internal Medicine (Licence: NY 299980) | |
| 207R00000X Internal Medicine (Licence: NJ 25MA10000400) | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2026-07-16 |