| NPI | 1033121751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 35366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME96553) |
| 207R00000X Internal Medicine (Licence: NY 241858) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2017-12-05 |