| NPI | 1720110547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA03887500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 2137731) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2010-02-22 |