| NPI | 1306885306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 186084) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 74604) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2016-06-16 |