| NPI | 1568596773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA00063735) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ MA00063735) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-07-08 |