| NPI | 1740856517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 335558) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V2257) |
| 208D00000X General Practice (Licence: NJ 25MA11964300) | |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2025-06-05 |