| NPI | 1619366515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 178427-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-054568) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2015-01-15 |