| NPI | 1629395629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA09229900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 278229) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2025-10-13 |