| NPI | 1326231077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME22765) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA19709) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2010-08-30 |