| NPI | 1588951115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 276180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 003816) |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2015-08-25 |