| NPI | 1407909021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA06422200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 220430) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2017-01-16 |