NPI | 1679972947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB09447600) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MB09447600) |
Enumeration Date | 2014-08-22 |
Last Update Date | 2014-08-22 |