| NPI | 1871588988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA06594200) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA06594200) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2008-02-28 |