| NPI | 1326062597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 131163) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 030601) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2024-04-16 |