| NPI | 1124054747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08077700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD428236) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2014-03-20 |