| NPI | 1558364166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA07544400) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: NH 22550) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2024-09-24 |