| NPI | 1245876143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 000453) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 000565) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2020-10-19 |