| NPI | 1902127566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 243810) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 269078) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2020-03-28 |