| NPI | 1083677223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 246827) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 12692) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2010-07-14 |