| NPI | 1619075694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA09067700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 225839) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2014-09-24 |