| NPI | 1821087305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 202245) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA64590) |
| 207R00000X Internal Medicine (Licence: FL ME0076915) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2008-06-10 |