| NPI | 1033114483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 128439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 123694) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2019-11-13 |