| NPI | 1740629112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 285809) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 285089) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2020-10-07 |