| NPI | 1851575724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 279834) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 051901) |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2015-07-02 |