| NPI | 1174531206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 252388) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A063765) |
| 207R00000X Internal Medicine (Licence: NC 2018-02599) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2018-12-03 |