| NPI | 1093863508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 158209) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA04295300) |
| 208D00000X General Practice (Licence: NJ 42953001) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2025-06-13 |