| NPI | 1922006352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA073387) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 230876-1) |
| 208000000X Pediatrics (Licence: NY 230876-1) | |
| 208000000X Pediatrics (Licence: NJ MA073387) | |
| Enumeration Date | 2005-07-10 |
| Last Update Date | 2010-06-30 |