| NPI | 1093823668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA07792000) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: NJ 25MA07792000) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-06-10 |