| NPI | 1184649535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 053546) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 198906) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2016-08-15 |