| NPI | 1912227125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: CA A148240) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R72287) |
| 207R00000X Internal Medicine (Licence: NY 262216) | |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: NY 262216-1) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2023-02-14 |