| NPI | 1396364840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 32189501) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB11975200) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2023-08-31 |