| NPI | 1184999161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C54087) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 232043) |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2023-10-23 |