| NPI | 1316056179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 178395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA05106300) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-02-15 |