| NPI | 1528139706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 39166) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 225169) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2020-04-05 |