| NPI | 1376627190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 133917) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA38869) |
| 207R00000X Internal Medicine (Licence: FL ME54639) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2012-12-04 |