| NPI | 1760633630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA a107319) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 60247609) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2021-10-06 |