| NPI | 1942200472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA04575900) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA04575900) |
| 207Q00000X Family Medicine (Licence: NJ 25MA04575900) | |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2011-05-26 |