| NPI | 1104356955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA11084600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.071327) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2024-06-17 |