| NPI | 1043292253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 044137) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 214190) |
| 207R00000X Internal Medicine (Licence: MA 220185) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2020-11-10 |