| NPI | 1205094315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI 15240) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A105849) |
| 207R00000X Internal Medicine (Licence: NY 283932) | |
| Enumeration Date | 2008-05-26 |
| Last Update Date | 2016-12-07 |