| NPI | 1689361487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 346147-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA12908300) |
| 207R00000X Internal Medicine (Licence: MI 4301513538) | |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2026-10-11 |