| NPI | 1972920007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 277104) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 290736) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2023-06-26 |