| NPI | 1003800095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 248639-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME87781) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2008-11-05 |