| NPI | 1245637784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A155281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 880229) |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2019-08-21 |