| NPI | 1134129125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB055637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB053566) |
| 207Q00000X Family Medicine (Licence: VA 0102049854) | |
| 207R00000X Internal Medicine (Licence: VA 0102049854) | |
| Enumeration Date | 2005-07-30 |
| Last Update Date | 2007-07-28 |