| NPI | 1861411647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 236499) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 232468) |
| 207R00000X Internal Medicine (Licence: CT 50367) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-01-05 |