| NPI | 1477948826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A162945) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09861500) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2019-10-09 |