| NPI | 1861524829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 73234) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 218383) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2023-02-13 |