| NPI | 1679036859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-165887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA11524500) |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2023-09-21 |