| NPI | 1255312856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA03590200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA03590200) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2010-02-19 |