| NPI | 1922167964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA03167300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 106427) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2025-12-10 |