| NPI | 1366992737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 255085-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R8E94) |
| 207R00000X Internal Medicine (Licence: IL 036.127243) | |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-10-10 |