| NPI | 1023116662 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 236514)  | 
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: MA 232437)  | 
| Enumeration Date | 2006-09-20 | 
| Last Update Date | 2010-02-26 |