| NPI | 1336187442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME99354) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 225438) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2011-08-18 |