| NPI | 1326043258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME82479) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA50376) |
| 207R00000X Internal Medicine (Licence: NY 167745) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2014-02-08 |