| NPI | 1972758787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 049139) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 131740114) |
| 282N00000X General Acute Care Hospital (Licence: NY 258371) | |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2011-05-18 |