| NPI | 1508848979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA07598200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 2342401) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2010-10-13 |