| NPI | 1225120744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 054072) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 205316) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-12-19 |