| NPI | 1760740088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 299742) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA11778100) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2023-06-29 |