| NPI | 1477611101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 22774) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 1410471) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-05-02 |