| NPI | 1093034530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G87963) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 140569-1) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2016-06-10 |