| NPI | 1578920641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD-20670) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 285583) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2019-12-01 |