| NPI | 1770615064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: NY 232962) |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: NJ 25MA08454800) |
| 207R00000X Internal Medicine (Licence: NJ 25MA08454800) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2011-08-03 |