| NPI | 1962470229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY NY200136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 200136) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2022-01-09 |