| NPI | 1881090504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101274471) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 302959) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2023-01-26 |