| NPI | 1669902441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB11071700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-09330) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2021-05-21 |