| 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 |