| NPI | 1235222449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 76052) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 219243) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2019-01-14 |