| NPI | 1366485930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 120968) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 120968) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2021-09-21 |