| NPI | 1568486249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB04501200) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NJ 25MB04501200) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-08-22 |