| NPI | 1376539205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 016644) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 117123) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2015-09-29 |