| NPI | 1962412478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 191458) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA07648700) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2022-12-09 |