| NPI | 1679554596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA5033700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME106556) |
| 207R00000X Internal Medicine (Licence: NY 175179) | |
| 207R00000X Internal Medicine (Licence: NC 2010-00655) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2011-05-25 |