| NPI | 1356518856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 278595) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 43138) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2019-11-13 |