| NPI | 1407833502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NY 233196) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 233196) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2011-07-16 |