| NPI | 1740325414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB10215600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 275282) |
| 111NN0400X Chiropractor, Neurology (Licence: NY X008240) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2024-09-06 |