| NPI | 1700291325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 224590) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G50049) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2014-06-23 |