| NPI | 1124078142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA07267000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA072670) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2015-02-05 |