| NPI | 1447541552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 63979) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 276689) |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2019-10-18 |