| NPI | 1215136254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 250412) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08476500) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2011-04-18 |