| NPI | 1811982200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08934100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 171066) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2018-12-05 |