| NPI | 1679507107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 325336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 217149) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2021-12-08 |