| NPI | 1316958762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA01927300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 088071-1) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |