| NPI | 1104938133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 147103) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 147103) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-10-07 |