| NPI | 1376879031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME147423) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08679200) |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2025-11-03 |