| NPI | 1487813036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NJ 25MA08841000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA08841000) |
| Enumeration Date | 2008-06-07 |
| Last Update Date | 2021-02-21 |