| NPI | 1699295501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA c197597) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25ma10749500) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2026-05-29 |