| NPI | 1336479898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 041479) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 225599) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2016-02-10 |