| NPI | 1174595136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 215037-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD068766L) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2011-09-15 |