| NPI | 1205922275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104030) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 193458) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2013-01-30 |