| NPI | 1245626522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 288730) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 56789) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2024-06-18 |