| NPI | 1396845632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA10528500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 232228) |
| 208000000X Pediatrics (Licence: NY 232228) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2019-05-20 |