| NPI | 1598962847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 265229) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL30146) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2020-12-11 |