| NPI | 1992971469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NJ 25MA09607200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09607200) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2021-06-02 |