| NPI | 1205161320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 258953) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101246234) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2023-05-08 |