| NPI | 1689929085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 277719) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 202845) |
| 207R00000X Internal Medicine (Licence: NJ NJDCATEMP-008277) | |
| Enumeration Date | 2012-07-21 |
| Last Update Date | 2020-05-19 |