| NPI | 1811914476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA60953) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME83954) |
| 207R00000X Internal Medicine (Licence: PA MA051464L) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2011-12-06 |