| NPI | 1578714861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD180984) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 250602) |
| Enumeration Date | 2008-10-04 |
| Last Update Date | 2018-12-18 |