| NPI | 1104003292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 260947) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 002824) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2012-06-13 |