| NPI | 1033290242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 201036) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY NY201036) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2016-03-03 |