| NPI | 1174578165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 252395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25ma07719100) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2013-02-07 |