| NPI | 1386716579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A94957) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08147700) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2009-04-15 |