| NPI | 1649365644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 50223) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 209103) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2018-03-17 |