| NPI | 1518088202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA04466800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 156339-1) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2012-12-25 |