| NPI | 1093794182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 76537) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 197149) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2024-01-29 |