| NPI | 1114123981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NJ 25MA12891300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 243475) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2025-11-06 |