NPI | 1598017634 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G88102) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA05404700) |
207R00000X Internal Medicine (Licence: NY 152564) | |
Enumeration Date | 2012-10-14 |
Last Update Date | 2012-10-14 |