| NPI | 1972044105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 296081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 296081-01) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2021-08-02 |