| NPI | 1508446014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB12277800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 329967) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2026-07-17 |