| NPI | 1497108856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U6050) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA10471800) |
| 207R00000X Internal Medicine (Licence: NJ 25MA10471800) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2023-09-25 |