| NPI | 1639210784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI 16432) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 023842) |
| 207R00000X Internal Medicine (Licence: NY 155403) | |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2020-02-03 |