| NPI | 1245363324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 102469-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 55054) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2018-08-17 |