| NPI | 1154396893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 039581) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 302563) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2020-01-25 |