| NPI | 1174695225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS10751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 210013) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2011-12-27 |