| NPI | 1861568701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 156780) |
| Additional Taxonomies | 281P00000X Chronic Disease Hospital (Licence: NY 156780) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2015-07-31 |