| NPI | 1700261278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 296607-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101271090) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2024-03-15 |