| NPI | 1306958285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01061851A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 240735) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-01-03 |