| NPI | 1447364922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25ma04463300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 162994) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2011-07-15 |