| NPI | 1164759445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: DC MD040496) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 259575) |
| Enumeration Date | 2009-11-07 |
| Last Update Date | 2019-01-10 |