| NPI | 1760492680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 234093) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 234093) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2013-01-29 |