| NPI | 1174688493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA06624900) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: NJ 25MA06624900) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2015-02-16 |