| NPI | 1598758625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A50189) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 186231) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2018-03-17 |