| NPI | 1528105640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA07446900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C154589) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2018-05-30 |