| NPI | 1790304962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 323863) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB11973800) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2026-08-12 |