| NPI | 1891935557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 025MA08530400) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NJ 025MA08530400) |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2015-03-18 |