| NPI | 1548558877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0028461) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09912600) |
| 207R00000X Internal Medicine (Licence: MD D0104296) | |
| 207R00000X Internal Medicine (Licence: CA A117427) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2026-03-25 |