| NPI | 1811059967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 161270) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08711300) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2023-05-03 |