| NPI | 1841652484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA11030900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101266551) |
| 207R00000X Internal Medicine (Licence: NY 314192) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2022-06-12 |