| NPI | 1851489892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 90063) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 115109) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2017-01-24 |