| NPI | 1760589147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 240149) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 195949) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-02-04 |