| NPI | 1245244987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB05712600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 187053) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2019-05-16 |