| NPI | 1609290519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 298081) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: NY 298081) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2019-12-11 |