| NPI | 1275594707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA05500100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA55001) |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2011-11-22 |