| NPI | 1548608391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101020646) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 302012) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2023-07-03 |