| NPI | 1609802057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA06535300) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NJ 25MA06535300) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2021-04-30 |