| NPI | 1760680466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104716) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08487200) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2015-10-14 |