| NPI | 1578667044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 283050) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA 47371) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2017-03-01 |