| NPI | 1518377951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 282648) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-43863) |
| 207R00000X Internal Medicine (Licence: NH LT3616) | |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2024-07-19 |