| NPI | 1518348739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NY 300039) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 300039) |
| 207R00000X Internal Medicine (Licence: CT 60794) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2023-07-22 |