| NPI | 1023497740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 275946) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101-037258) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2016-10-26 |