| NPI | 1811023682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA 61265) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ MA 61265) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |