| NPI | 1689695223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 192741) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 192741) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2012-05-31 |