| NPI | 1962671016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 289336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 49199) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2022-12-28 |