| NPI | 1609902493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08218800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD430702) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |