| NPI | 1740394949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS23055) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB07397400) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2026-03-16 |