| NPI | 1306876602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB07552900) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 214845) |
| 207Q00000X Family Medicine (Licence: NY 214845) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2014-11-06 |