| NPI | 1588891998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C155199) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 247262) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2018-07-11 |