| NPI | 1710036520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 216824) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 249677) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2018-04-03 |