| NPI | 1215904172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 40402) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 164677) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2019-11-15 |