| NPI | 1619275849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 261950-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08896000) |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2012-02-27 |