| NPI | 1255385233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA63577) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ MA63577) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2015-10-28 |