| NPI | 1013278860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 278451) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 251563) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2016-01-11 |