| NPI | 1669505905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL me73112) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 19631401) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2021-06-07 |