| NPI | 1215929955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 026495) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 288189) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2018-03-26 |