| NPI | 1447265228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 20638) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 1650191) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2012-01-10 |