| NPI | 1104902006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MD062414L) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD062414L) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: NJ 25MA09329300) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2023-03-30 |