| NPI | 1184924250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 092269-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA01995500) |
| Enumeration Date | 2010-10-23 |
| Last Update Date | 2010-10-23 |