| NPI | 1407992316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 26866) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 185391-1) |
| 207R00000X Internal Medicine (Licence: NY 185391) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2023-10-04 |