| NPI | 1104129014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 44344) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 259711) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2019-11-06 |