| NPI | 1760650394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA06029400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 38451 - 020) |
| Enumeration Date | 2008-02-17 |
| Last Update Date | 2017-04-21 |