| NPI | 1679983159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 299939-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA10676700) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2025-12-19 |