| NPI | 1962923714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA11378500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 305799) |
| 207R00000X Internal Medicine (Licence: NE 7979) | |
| Enumeration Date | 2017-07-02 |
| Last Update Date | 2022-07-15 |