| NPI | 1962432799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 1583341) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA07875500) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2010-10-08 |