| NPI | 1245345743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NJ 25MA04362400) |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: NJ 25ma04362400) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2019-07-03 |