| NPI | 1942434147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 020944) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 191947) |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2019-11-19 |