| NPI | 1124212758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 278990) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 050464) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2018-08-10 |