| NPI | 1235130196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 116426) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA07048200) |
| 207R00000X Internal Medicine (Licence: CT 040695) | |
| 207R00000X Internal Medicine (Licence: PA MD424333) | |
| 207R00000X Internal Medicine (Licence: DE C1 0007322) | |
| 207R00000X Internal Medicine (Licence: CA G80040) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2007-07-08 |