| NPI | 1154676674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 277395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 053319) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2016-03-02 |