| NPI | 1801878269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA07504600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 2325031) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2025-02-18 |