| NPI | 1407869985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA07309700) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NJ MA073097) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2021-06-04 |