| NPI | 1710405170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 2VI00726000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 013368) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2022-07-21 |