| NPI | 1831175009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 120781) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 120781) |
| 207RP1001X Internal Medicine Pulmonary Disease (Licence: NY 120781) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2014-02-24 |