| NPI | 1225292873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C152581) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 249493) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2018-10-23 |