| NPI | 1154591931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 253055) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 234639) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2009-08-29 |