| NPI | 1205859188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME81857) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 204864) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2019-05-07 |