| NPI | 1023106838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 241612-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 241612) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-01-31 |