| NPI | 1205868437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 99179) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 091665) |
| 207R00000X Internal Medicine (Licence: NY 091665-1) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2009-01-21 |