| NPI | 1558392779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M6146) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA67825) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-08-01 |