| NPI | 1831330349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 248990) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 307997) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2021-04-12 |