| NPI | 1558651737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA09893300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C1-0025058) |
| Enumeration Date | 2011-04-09 |
| Last Update Date | 2022-07-27 |