| NPI | 1932586765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 64465) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 305171) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2024-04-29 |