| NPI | 1306261086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 273668-1) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 273668-1) |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2019-02-19 |