| NPI | 1164680500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25ma09029300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301091889) |
| Enumeration Date | 2008-05-31 |
| Last Update Date | 2025-05-16 |