| NPI | 1750473096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 30161) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 241487) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2010-04-14 |