| NPI | 1144589730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA09201500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101251474) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2013-08-01 |