| NPI | 1659372829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA06036000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 189494) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-03-07 |