| NPI | 1154323012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY ny175847-1) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 175847-1) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2016-05-25 |