| NPI | 1104162767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0000X Internal Medicine Adolescent Medicine (Licence: NJ 25MA09309800) |
| Additional Taxonomies | 207RI0200X Internal Medicine Infectious Disease (Licence: NJ 25MA09309800) |
| Enumeration Date | 2012-12-28 |
| Last Update Date | 2024-05-02 |