| NPI | 1144712878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA11462400) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD476991) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2022-10-02 |