| NPI | 1073516191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 166249-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042.0013988) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2019-07-05 |