| NPI | 1154332062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 234979) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD455301) |
| 207R00000X Internal Medicine (Licence: FL ME 94418) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-05-13 |