| NPI | 1376047647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A179808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 311681) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-10-22 |