| NPI | 1235127150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C138034) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 125005) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2022-11-30 |