| NPI | 1861971962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD484626) |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: PR 24403) |
| 207R00000X Internal Medicine (Licence: NJ 25MA11685800) | |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2025-09-25 |