| NPI | 1750733242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA12620500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD24129) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2025-06-10 |