| NPI | 1760657050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1014281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 261684) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2023-09-21 |