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 |