| NPI | 1548274111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ ma03577100) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NJ ma03577100) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2010-06-28 |