| NPI | 1952712788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 13210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 29118) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2020-11-18 |