| NPI | 1215013354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 068726) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 214695) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2013-07-29 |