| NPI | 1063450591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08506700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME95068) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2010-07-13 |