| NPI | 1194917963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08448500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 244102) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2013-07-31 |