| NPI | 1548524838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB10216800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H0080401) |
| 207Q00000X Family Medicine (Licence: VA 0116025196) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2018-03-26 |