| NPI | 1275112138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA12810700) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME163382) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2025-08-14 |