| NPI | 1225151665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 253147) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.116969) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2014-05-27 |