| NPI | 1902956121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 036755) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 186939) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2010-08-17 |