| NPI | 1780879163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 100032) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 245861) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2011-10-26 |