| NPI | 1396700795 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA07968600) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 331087014) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 760760601) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 043851266) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2023-10-18 |