| NPI | 1740629948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 173037-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA05299100) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2013-06-20 |