| NPI | 1407959976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC TL31368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA05486500) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2008-10-31 |