| NPI | 1629158407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA06179400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA061794) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2019-02-26 |