| NPI | 1760432215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA04727700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA04727700) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA04727700) | |
| 208600000X Surgery (Licence: NJ 25MA04727700) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-10-19 |