| NPI | 1740448208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 249063) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 13999) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2011-12-31 |