| NPI | 1457346165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME93229) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA07863400) |
| 208D00000X General Practice (Licence: NJ 25MA07863400) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2024-02-19 |