| NPI | 1649249582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA067592) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 211102) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-10 |