| NPI | 1356320410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 230232) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 041643) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2010-08-02 |