| NPI | 1811371420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME144010) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25ma09737600) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2026-07-21 |