| NPI | 1861934945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 248832-1) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: OR MD167144) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2016-11-07 |