NPI | 1902087562 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 153452-1) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA04372900) |
207R00000X Internal Medicine (Licence: FL ME97204) | |
Enumeration Date | 2007-11-23 |
Last Update Date | 2007-11-23 |