| NPI | 1770673824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD12080) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC 12080) |
| 207R00000X Internal Medicine (Licence: MD D0026382) | |
| 207R00000X Internal Medicine (Licence: NY 302575) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-02-03 |