| NPI | 1851897789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 332046) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA11342500) |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2025-08-01 |