| NPI | 1205008588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA c55520) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MD08262800) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI01717500) | |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2026-03-05 |