| NPI | 1659599256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08629700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 253981) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2023-05-11 |