| NPI | 1548302888 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: NY 115362)  | 
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: NY 115362-1)  | 
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: FL ME93816)  | |
| Enumeration Date | 2007-02-13 | 
| Last Update Date | 2010-12-09 |