| NPI | 1215110283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101246303) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 249479) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2010-10-25 |