| NPI | 1972764314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08423600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.092743) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2022-12-08 |