| NPI | 1508386376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G152698) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08070300) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-07-21 |