| NPI | 1326023953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 165665) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NY 1656651) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2014-03-02 |