| NPI | 1326197963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 000529) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 203678) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |