| 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 |