| NPI | 1568447993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 213152-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 213152) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2014-03-11 |