| NPI | 1063561413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA069970) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NJ ma069970) |
| 208000000X Pediatrics (Licence: NJ MA069970) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2011-02-02 |