| NPI | 1053302976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA07930800) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA07930800) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2023-10-04 |