| NPI | 1336436468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR 177592) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 276188) |
| Enumeration Date | 2011-07-10 |
| Last Update Date | 2016-06-14 |