| NPI | 1730241159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 42606) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08034600) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2010-11-17 |