| NPI | 1275731986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 2508676200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 00324019) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2022-10-07 |