| NPI | 1962899187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA04100900) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: NJ 25MA04100900) |
| Enumeration Date | 2015-04-26 |
| Last Update Date | 2018-08-30 |