| NPI | 1801042072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25ma08461900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 249361-1) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2021-06-24 |