| NPI | 1790172229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 065807) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2015-0394) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NM MD2015-0394) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 221296) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2023-07-10 |