| NPI | 1235445859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 2706941) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A113372) |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2022-02-11 |