| NPI | 1164860961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 292463) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 272463) |
| 207R00000X Internal Medicine (Licence: CT 55573) | |
| 207R00000X Internal Medicine (Licence: IL 125062580) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2021-05-03 |