| NPI | 1083705552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME98807) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA05589500) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2013-01-10 |