| NPI | 1013072156 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE c1-0005652)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 181861)  | 
| Enumeration Date | 2006-12-27 | 
| Last Update Date | 2011-11-08 |