| NPI | 1861661704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB08679900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 243528) |
| 208D00000X General Practice (Licence: NY 243528) | |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2021-09-26 |