| NPI | 1700306925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25IB12638200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8047) |
| 207R00000X Internal Medicine (Licence: TX T1597) | |
| 208000000X Pediatrics (Licence: TX T1597) | |
| 208000000X Pediatrics (Licence: NE 8047) | |
| 208000000X Pediatrics (Licence: NJ 25IB12638200) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2025-08-26 |