| NPI | 1538154307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA06930200) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA06930200) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2008-02-22 |