| NPI | 1609192608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 269640) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 50077) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2023-05-12 |