| NPI | 1982750360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 196278) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 196278) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2012-03-17 |