| NPI | 1912009879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 292344) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25ma07938000) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2023-03-07 |