| NPI | 1033119136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 201034) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101264610) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2021-04-07 |