| NPI | 1184890618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 116063) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: NY 116063-1) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2008-07-23 |